Housing First: The best bet to end homelessness

From 2002 to 2008, the counted number of homeless in Metro Vancouver increased 137 per cent, from 1,121 to 2,660. What is equally important, from 30 to 50 per cent (with some estimating as high as 70 per cent) of the homeless population in Vancouver have mental health concerns. An unfortunate result of de-institutionalization is that the burden of mental healthcare has fallen on the police and general hospitals. To solve homelessness, we can't just build homes. We must also successfully address the mental health concerns of the homeless.

In Vancouver, even if all the planned housing is built, the bulk of the homeless population, those without diagnosis and/or currently using drugs will be left out in the cold. A program known as "Housing First," aims to target this group, getting people into housing while also addressing their mental health and addictions needs.

In Canada today, we are seeing overlapping gaps, as multiple social systems -- including housing and healthcare -- crack under pressure. Housing First was the subject of a pilot program in Toronto five years ago. It was so successful that the federal government has put $110 million dollars towards a national research project on it. The five-city study, by the Mental Health Commission of Canada, aims to search for solid evidence supporting Housing First on a national level, as a cornerstone for ending homelessness in Canada.

As its name implies, the program provides housing first, followed by rehabilitation and treatment, to the homeless who are mentally ill. Around 1,350 people are taking part in Vancouver, Winnipeg, Toronto, Montreal, and Moncton. Simultaneously, a different group of another 1,000 homeless with received the healthcare and social services they need, but not the housing. Both groups will be tracked to determine the success of each method. The program will run until 2013.

Traditional supportive housing leaves an enormous gap. It does not cover those with undiagnosed mental illness or those currently using drugs. We know about the social determinants of mental health, the integration between mental health and the health of a person's body and environment. We cannot hope to successfully treat a person who is still sleeping rough. The best tool to end homelessness is one like Housing First, that addresses all of a person's relevant needs and concerns, including housing, mental health and addictions.

Over-burdened police and hospitals

Currently, in Vancouver the police are, in effect, frontline mental healthcare workers. Mental illness is a factor in nearly half of all emergency calls in the Downtown Eastside where contact is made. Our general hospitals act as replacements to psychiatric hospitals, resulting in higher costs and fewer beds available for other patients. Plus, they lack the ability to provide long-term care.

For many, de-institutionalization has been a success. But, as Dr. Michelle Patterson, professor at Simon Fraser University and co-investigator on the MHCC study, puts it: "the problem was that people were moved out of institutions and the community-based services were not made available, and so there was a real gap created."

Many times the hospital will turn people with mental illness away, due to lack of space and resources. Knowing that hospital space isn't available, the police often use jails instead. Says Dr. Patterson, "it is a very ineffective and expensive way of serving people's mental health needs". Shifting the homeless into supported housing represents a large cost savings, estimated at $16,282 per unit of supportive housing, per year.

Under the current system, a person cannot enter mental health-supported housing without a diagnosis. People who are relatively functional, who have the wherewithal or social support to get a diagnosis, are well taken care of. But, if a person is currently using drugs, mental health professionals will not make a diagnosis until the individual is clean and sober. As well, many do not have the ability to identify themselves as being in need, or to make the many appointments necessary to be diagnosed.

Those without a diagnosis and those who are concurrently using drugs have few choices. They may find support after being identified by the police and taken to the hospital, but this is a clear last resort.

The need is great

Mental health is obviously one of the cornerstones of homelessness, in Vancouver and nationally. But even if the City of Vancouver builds all the supportive housing it has promised, the needs of those with undiagnosed mental health and/or current substance abuse concerns will not be sufficiently addressed. Under the current Vancouver Supportive Housing Strategy, out of the 13 buildings, only three will accept a person who has undiagnosed mental health concerns or is still using drugs.

Data on the number of homeless with mental health concerns is difficult to gather precisely, but the trend is clear. In Vancouver the estimates range from 30 to 50 per cent (with some estimating as high as 70 per cent). In Toronto, the number is put at 67 per cent. In Montreal, the estimates range from 50-80 per cent.

We know about the social determinants of mental health, the integration between mental health and the health of a person's body and environment. The best tool to end homelessness will be one that addresses all of a person's relevant needs and concerns, including housing, mental health and addictions.

Housing First works

Housing First is new, but it's not experimental. It has been tested and used elsewhere in Canada. In 2007, the city of Toronto piloted Housing First with a small group of 300. The city was impressed enough with the results of the pilot to use low-barrier supportive housing, Housing First, as the backbone of the supportive element of their 2009 city-wide housing initiative. Montreal is in the middle of Opération 15,000 logements, a citywide push to add 15,000 additional unit of affordable housing, including supportive housing.

Recently, the Mental Health Commission of Canada was given $110 million by the federal government, for the five city, landmark study on Housing First. This study is just getting underway. When the study concludes in 2013, we will have a large set of hard evidence on Housing First. But there is no reason to wait, we can move forward with this program now.

We know that the capacity of community-based mental health care has not sufficiently increased to cover the demand left by de-institutionalization. We know that the best tool to end homelessness will address housing, mental health and addictions. This new study on Housing First should be used as a rallying point for the creation of a national housing strategy, including low-barrier supportive housing. In Vancouver, we must build on the work already done and increase the proportion of supportive housing that is "Housing First," making it a top priority on the ground and in city planning.

Carrie Baptist is the former news director for CiTR News, 101.9 FM in Vancouver. She works as a social worker in Vancouver's Downtown Eastside.

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